Militello v. St. Agnes Medical Center - PAfamily.net

40 Pages·2008·0.13 MB·English

GOLD,BUTKOVITZ&ROBINS,P.C. ATTORNEYFORDEFENDANT,
BY:ALANS.GOLD JOHNF.McCORMICK,M.D.
ATTY.ID.NO. 23400
BY:SEANROBINS
ATTY.ID.NO.68828
7837OLDYORKROAD
ELKINS PARK,PA19027
[phone]
RUSSELL MILITELLO : PHILADELPHIACOUNTY
COURT OFCOMMONPLEAS
:
V. : FEBRUARYTERM,2002
ST.AGNES MEDICAL CENTER,etal. : NO.1588
O RDE R
This matterhavingcomebeforetheCourt upontheMotionforSummaryJudgment of
Defendant,JohnF.McCormick,M.D.; andtheCourt havingconsideredthesubmissions in
support oftheMotion; andhavingconsideredthesubmissions inoppositionthereto; andfor
goodcauseshown;
ITIS THIS ________dayof____________________,2004,herebyORDERED,that the
MotionforSummaryJudgment ofDefendant,McCormick,is herebyGRANTED,andsummary
judgment is enteredinhis favorandagainst thePlaintiff,andthePlaintiff’s claims aretherefore
DISMISSEDWITHPREJUDICEas against Dr.McCormick.
BYTHECOURT:
________________________________________
J.
GOLD,BUTKOVITZ&ROBINS,P.C. ATTORNEYFORDEFENDANT,
BY:ALANS.GOLD JOHNF.McCORMICK,M.D.
ATTY.ID.NO. 23400
BY:SEANROBINS
ATTY.ID.NO.68828
7837OLDYORKROAD
ELKINS PARK,PA19027
[phone]
RUSSELL MILITELLO : PHILADELPHIACOUNTY
COURT OFCOMMONPLEAS
:
V. : FEBRUARYTERM,2002
ST.AGNES MEDICAL CENTER,etal. : NO.1588
MOTIONFORSUMMARYJUDGMENT OF
DEFENDANT,JOHNF.MCCORMICK,M.D.
MovingDefendant,JohnF.McCormick,M.D.(“McCormick”),byandthroughhis
attorneys, Gold,Butkovitz &Robins, P.C.,herebymoves beforethis HonorableCourt foran
OrdergrantingSummaryJudgment inhis favor,andagainst thePlaintiffs ontheirThird
AmendedComplaint,andinsupport whereof,stateas follows:
1. This matterwas commencedbythePlaintiffs withthefilingofaWrit of
Summons onFebruary12,2002.
2. OnFebruary26,2002,aPraecipeandRuletoFileComplaint werefiledand
served,andonorabout March21,2002,thePlaintiffs filedaComplaint.
3. PreliminaryObjections tothePlaintiffs Complaint werefiled,towhichPlaintiffs
respondedbyfilinganAmendedComplaint,onorabout May30,2003.
4. PreliminaryObjections werethereafterfiledas toPlaintiffs’AmendedComplaint,
andonorabout July10,2002,Plaintiffs filedaSecondAmendedComplaint.
5. OncemorePreliminaryObjections followed,as toPlaintiffs’SecondAmended
Complaint,andoncemorePlaintiffs respondedwiththefilingofaThirdAmendedComplaint on
orabout August 19,2002. (AcopyofthePlaintiffs’ThirdAmendedComplaint is attached
heretoas Ex.“A”)
6. PreliminaryObjections tothePlaintiffs’ThirdAmendedComplaint werefiled.
7. ByOrderdatedOctober24,2003,theCourt grantedinpart certainPreliminary
Objections tothePlaintiffs’ThirdAmendedComplaint,as follows:
...All references to: recklessness,conduct inreckless disregard,or
willful andwantonconduct andall claims forpunitivedamages
containedinparagraphs 53,54,57,58,59,59(i),60,64,65,66,
66(i),67,98,99,102,104,105andinthe“wherefore”clause
followingparagraph105andall otherclaims forpunitivedamages
arestricken; ...
8. Plaintiffs, intheirThirdAmendedComplaint,attempt toset forthclaims of
medical malpracticeandprofessional negligenceas toeachofthedefendants: St.Agnes Medical
Center(“St.Agnes”),CatholicHealthEast,MarcChristopherPetrone,M.D.(“Petrone”),as well
as movingdefendant,JohnF.McCormick,M.D.
9. PennsylvaniaRuleofCivil Procedure1035sets forththestandardforgranting
summaryjudgment. It states inrelevant part:
Aftertherelevant pleadings areclosed,but withinsuchtimeas to
not unreasonablydelaytrial,anypartymaymoveforsummary
judgment inwholeorinpart as amatteroflaw(1)wheneverthere
is nogenuineissueofanymaterial fact as toanecessaryelement of
thecauseofactionordefensewhichcouldbeestablishedby
additional discoveryorexpert report,or(2)if,afterthecompletion
ofdiscoveryrelevant tothemotion,includingtheproductionof
expert reports, anadversepartywhowill beartheburdenofproof
at trial has failedtoproduceevidenceoffacts essential tothecause
ofactionordefensewhichinajurytrial wouldrequiretheissues to
besubmittedtoajury.
10. InErtel v.Patriot-News Co.,544Pa.93,674A.2d1038, cert.denied,519U.S.
1008,117S.Ct.512(1996),theSupremeCourt ofPennsylvaniaadoptedtheapproachofthe
SupremeCourt oftheUnitedStates tosummaryjudgment. It heldthat henceforth,inorderto
defeat amotionforsummaryjudgment,thepartyagainst whom themotionis directedmust
submit sufficient evidenceoneveryissueessential tohis caseonwhichhebears theburdenof
prooftosupport ajuryverdict inhis favor. Id.at 674A.2dat 1042.
11. Inthis case,thePlaintiffs havepresentedinsufficient evidencetosupport ajury
verdict intheirfavoras totheirclaims ofmedical malpracticeas against movingdefendant,Dr.
McCormick. Todefeat Dr.McCormick’s motionforsummaryjudgment,thePlaintiffs must
establish theexistenceofsufficient evidencetosupport ajuryverdict intheirfavoronall
elements ofthecauseofactionforwhichtheyhavetheburdenofproof. Ertel,544Pa.93,674
A.2dat 1042.
12. Plaintiffs’allegethat theirdecedent,Ms.JosephineMilitello(“Militello”),was
admittedtoSt.Agnes Medical Centeronorabout June20,2001byherattendingphysician,
defendant,Dr.Petrone,withadmittingdiagnoses ofchronicrenal failure,digoxintoxicityand
insulindependant diabetes mellitus. (Ex.“A”,at ¶9)
13. Amongvarious medications, Plaintiffs’allegethat Ms.Militellowas receiving
Coumadin(ananticoagulant medication)at thetimeofheradmissiontoSt.Agnes. (Ex.“A”,at
¶13)
14. Plaintiffs allegethat onJune5,2001,Ms.Militello’s INR ratio(ameasureofher
blood’s anticoagulation)was miscalculatedas being1.61,...(Ex.“A”,at ¶17)
15. Plaintiffs allegethat onJune7,2001,Ms.Militello’s INR ratiowas miscalculated
as being2.22,but that it was laterdeterminedtohaveactuallybeen5.25. (Ex.“A”,at ¶¶21and
23)
16. Plaintiffs allegethat onJune8,2001,Ms.Militello’s INR ratiowas miscalculated
as being2.42,but that it was laterdeterminedtohaveactuallybeen6.29. (Ex.“A”,at ¶¶24and
26)
17. Plaintiffs allegethat onJune9,2001,Ms.Militello’s INR ratiowas miscalculated
as being2.27,but that it was laterdeterminedtohaveactuallybeen5.51. (Ex.“A”,at ¶¶27and
29)
18. Plaintiffs allegethat onJune10,2001,Ms.Militello’s INR ratiowas
miscalculatedas being2.18,but that it was laterdeterminedtohaveactuallybeen5.08. (Ex.
“A”,at ¶¶31and33)
19. Plaintiffs allegethat onJune11,2001,Ms.Militello’s INR ratiowas
miscalculatedas being2.18,but that it was laterdeterminedtohaveactuallybeen5.04. (Ex.
“A”,at ¶¶34and36)
20. Plaintiffs allegethat onJune12,2001,Ms.Militello’s INR ratiowas
miscalculatedas being2.06,but that it was laterdeterminedtohaveactuallybeen4.50. (Ex.
“A”,at ¶¶37and39)
21. Plaintiffs allegethat onJune13,2001,Ms.Militello’s INR ratiowas
miscalculatedas being2.06and2.11,but that it was laterdeterminedtohaveactuallybeen4.50
and4.74. (Ex.“A”,at ¶¶40-41,46and49)
22. Plaintiffs’allegethat theimpropercalculations ofMs.Militello’s INR ratio
“contributedto[Ms.Militello’s] demiseandultimatedeath.” (Ex.“A”,at ¶54)
23. Specificallywithrespect tomovingdefendant,McCormick,Plaintiffs allegein
theirThirdAmendedComplaint as follows:
7. At all times material hereto,Defendant JohnF.
McCormick,M.D.(“Dr.McCormick”)was aphysician
dulylicensedtopracticeintheCommonwealthof
Pennsylvaniaandwas engagedinthepracticeofhis
professioninPhiladelphia,Pennsylvaniaat SAMC.
***
79. Defendant,Dr.McCormick,was aphysicianwho
undertooktodiagnose,treat andotherwisecarefor
Decedent onorabout June2,2001,inthecourseofhis
practiceat SAMC.
80. Defendant,Dr.McCormick,undertooktheaforesaidcareof
Decedent withtheknowledgeandintentionthat Plaintiff
would relyonDefendant’s opinions, trainingand
experienceinregardtothemedical carerenderedtoher
duringthecourseofhercareandtreatment at SAMC.
81. Defendant,Dr.McCormick,undertooktheaforesaidcareof
Decedent forcompensationrenderedbyDecedent oron
behalfofDecedent.
82. Defendant,Dr.McCormick,heldhimselfout toDecedent
andthepublicas anexpert inmedicine.
***
84. Defendant,Dr.McCormick,owedadutyofcareto
Decedent whichwas breachedtoDecedent’s great
detriment.
85. Defendant,Dr.McCormick,breachedhis dutyofcareto
Decedent withknowledgeandreckless disregardforher
safetytohergreat detriment bynumerous acts or
omissions, inthefollowingways:
(a) failingtoproperlymonitorDecedent’s
laboratoryvalues, includingPT,INR andPTT,in
that hefailedtorecognizethat thesevalues were
improperlycalculatedandfailedtoensuretheywere
properlycalculatedso that thedecedent wouldnot
beover-anticoagulatedleadingtoherdeath;
(b) failingtotakepropersteps toensurethat
Decedent’s laboratoryresults wereaccurateby
failingtorecognizethemiscalculations andfailing
todoanythingtoensurethevalues wereproperly
calculatedandherclottingabilitywas increased;
(c) failingtoproperlyinterpret Decedent’s
laboratoryresults inlight ofinconsistent laboratory
values;
(d) failingtorepeat Decedent’s erroneous
laboratorytests includingPT,PTTandINR ratios to
ensurethat shewas not over-anticoagulatedleading
toherdeath;
(e) failingtoconsistentlymonitorDecedent’s
HGBandHCTlevels duringheradmissionto
recognizethesigns ofexcess anticoagulation;
(f) failingtotimelydiagnoseandtreat Decedent’s
bleedinginthefaceofmiscalculatedPT,PTTand
INR ratios;
(g) failingtoconduct anaccurateandfull medical
assessment ofDecedent includinganevaluationof
all ofherlaboratoryresults andclinical signs and
symptoms whichwouldhaverevealedthat shewas
anemicandhadbeenexcessivelyanticoagulated
givenheractual INR ratios hadtheybeenproperly
calculated;
(h) failingtoproperlytrainandsupervisethe
medical/surgical residents toappreciatethesigns
andsymptoms ofanemiaandbleedingand
recognizethat thePT,PTTandINR ratios hadbeen
improperlycalculated;
(I) failingtoproperlytrainandsupervisethe
nursingstafftoappreciatetheclinical signs and
symptoms ofanemiaandbleedingandrecognize
that thePT,PTTandINR ratios hadbeen
improperlycalculated;
(j) failingtoensurethat Decedent was stableprior
toundergoinganysurgical procedures, including
herclottingfactors;
(k) failingtoconduct properlaboratoryand
diagnostictests priortoDecedent’s surgical
procedureonJune13,2001so as torecognizethat
shehadbeenexcessivelyanticoagulatedandwas at
asignificant risk forabnormal bleedinganddeath;
and
(l) failingtoconduct properlaboratoryand
diagnostictests subsequent toDecedent’s surgical
procedureonJune13,2001toproperlydetermine
herclottingfactors so that steps couldhavebeen
takentoincreasehercoagulationandsaveherlife.
24. ThedeathcertificateissuedfollowingMs.Militello’s deathonJune13,2001,
however,indicates as hercauseofdeath: “kidneyfailure.” (SeeacopyoftheCertificateof
Death,attachedheretoas Ex.“C”)
25. ThePhiladelphiaMedical Examiner,Haresh G.Mirchandani,M.D.reviewedMs.
Militello’s death,its circumstances andhermedical records, andconcludedthat hercauseof
deathwas renal failure. (Ex.“D”,DepositionofHaresh G.Mirchandani,M.D.,at 43; Ex.“E”,
DeathCertificateInformation,at1and6) AccordingtoDr.Mirchandani,“[t]herewas noclinical
evidenceofbleeding”andthat “[t]hedeathofthis patient was not theresult oftreatment
(coumadin)received.” (Ex.“E”,at 6; Ex.“D”,at 31-32)
26. Likewise,Ms.Militello’s attendingphysician,defendant,Dr.Petrone,whotreated
Ms.Militelloduringherhospitalization,testifiedthat hefoundnoclinical evidenceofany
bleeding,andthat it was his opinionthat shehaddiedas aresult ofkidneyfailure,andnot as a
result ofhavingbeengiventoomuchcoumadin. (SeedepositionofDr.Petrone,Ex.“F”,at 11)
Dr.Petronedeterminedthat Ms.Militello’s deathwas causedbyrenal failure,andlistedit as the
causeofdeathonherdeathcertificate. (Ex.“F”,at 79-80) Hewas verycertainthat herdeath
was causedbyrenal failureat thetime,andheremains so tothis day. ThecorrectedINR values
receivedat alaterdatedonot changehis mind. (Ex.“F”,at 80)
27. Dr.Petronetestifiedthat thereis noclinical evidencethat Ms.Militellowas
bleedingduringheradmission. (Ex.“F”,at 81) Herhemoglobinandhematocrit results were
stablethroughout heradmission. Dr.Petronetestifiedas totheonemarkedlylowhemoglobin
level onJune13,2001,that:
It was not consistent withherotherhemoglobin
values andit was not consistent withherphysical
exam. Sowerepeatedit,as wefrequentlydowhen
there’s alabthat looks likeaquote,“redherring.”
Andit camebackactually,therepeat,inlinewith
herprevious hemoglobin. (Ex.“F”,at 81-82)
28. Initially,toset forthaprimafaciecaseofmedical malpractice,aplaintiffmust
establish forthings: (1)theexistenceofadutyowedbythephysiciantothepatient,(2)abreach
ofthat dutyfrom thephysiciantothepatient,(3)that thebreachofthat dutywas theproximate
cause,orasubstantial factor,inbringingabout theharm sufferedbythepatient,and(4)the
existenceofdamages sufferedbythepatient that werethedirect result ofthat harm. Mitzelfelt v.
Kamrin,526Pa.54,584A.2d888,891(1990).
29. Toestablish acauseofactionformedical malpracticebasedonnegligence,the
SupremeCourt ofPennsylvaniarequires that plaintiffs present expert testimony,toareasonable
degreeofmedical certainty,that theacts ofthephysician-defendant deviatedfrom theapplicable
standardofcare,andthat suchdeviationconstitutedtheproximatecauseoftheharm suffered.
Brannanv.LankenauHospital,490Pa.588,417A.2d196(1980); Mitzelfelt,526Pa.54,584
A.2dat 892. Aplaintiffinamedical malpracticeaction“must present expert testimonyto
establish that thecareandtreatment oftheplaintifffell short oftherequiredstandardofcareand
that thebreachproximatelycausedtheplaintiff’s injury.” Toogoodv.Rogal,573Pa.245,824
A.2d1140,1145(2003). Theburdenis upontheplaintifftoshow,throughexpert testimony,
that thephysicianinquestion“failedtoemploytherequisitedegreeofcareandskill.” Toogood,
573Pa.245,824A.2dat 1150.
30. As ageneral matter,aphysicianwhois not aspecialist,“is requiredto possess
andemployinthetreatment ofapatient theskill andknowledgeusuallypossessedbyphysicians
inthesameorasimilarlocality. Donaldson v.Maffucci,397Pa.548,156A.2d835,838(1959).
31. ThePlaintiffs havefailedtopresent anyexpert testimonywhatsoeversettingforth
thestandardofcareapplicabletoaphysicianinDr.McCormick’s position,andopiniontoa
reasonabledegreeofmedical certaintythat theacts ofDr.McCormickconstitutedtheproximate
causeofharm sufferedbyMs.Militello. This failureis fatal tothePlaintiffs’claims against Dr.
McCormick,andrequireagrant ofsummaryjudgment inDr.McCormick’s favor.
32. InEaddyv.Hamaty,694A.2d639(Pa.Super.1997),theCourt consideredan
appeal ofthegrant ofsummaryjudgment enteredinfavorofdefendant-physicianbythetrial
court. Thetrial court hadgrantedsummaryjudgment onthegrounds that theopinionof
plaintiff’s expert thereinfailedtoestablish, toareasonabledegreeofmedical certainty,that the
actions ofthedefendant breachedtheapplicablestandardofcareas tohis patient andthat they
weretheproximatecause(orsubstantial factor)inbringingabout theharm alleged. Id.at 642-
643. TheSuperiorCourt foundthat theplaintiff’s expert “didnot express therequisitedegreeof
medical certainty”andthat theplaintifftherefore“failedtostateaprimafaciecaseofmedical
malpractice”as tothedefendant-physician,Dr.Hamaty:
Dr.Mitchell [plaintiff’s expert]opinedwithareasonabledegreeof
medical certaintythat thesteroids, intheabsenceofothercauses,
ledtothedevelopment ofavascularnecrosis. Hedid notidentify
anyconducton thepartofthetreatingphysician as abreach of
duty,e.g.,that Dr.Hamatynegligentlyoverprescribedthe
medication,that henegligentlyprescribedPrednisoneinlight of
otheralternatives, orthat henegligentlyprescribedPrednisonefor
anexcessiveperiodoftime. Nordid heidentifyanybreach as a
proximatecauseof,orasubstantial factorin,appellant’s
harm....Afterreviewingtheexpert report inits entirety,we
concludethat Dr.Mitchell didnot express therequisitedegreeof
medical certainty. Appellant thereforefailedtostateaprimafacie
caseofmedical malpractice.(Id.at 642.)(emphasis added)
Whilecarefullyandclearlydeterminingthat thePlaintiffin Eaddyhadfailedtodemonstratea
breachintheapplicablestandardofcarebyDr.Hamatyduetotheexpert’s failuretoprovidean
opinionas totheactions ofDr.Hamaty,theSuperiorCourt sent thematterbacktothetrial court
solelyuponaprocedural technicality: theCourt hadruledonthedefendant’s summaryjudgment
motionwithout providingthePlaintiffwith30days afterserviceofthemotiontofilearesponse.
Nonetheless,theholdingis clear: Iftheplaintifffails toprovideanexpert opinionas towhether
andhowthedefendant-physician’s actions havebreachedadutytothepatient,andthat such
breachwas theproximatecauseoforsubstantial factorintheresultingharm,theclaim must fail.
33. Thesoleexpert opinionpresentedbythePlaintiffs is that ofBarryL.Singer,
M.D.,whohas providedanopinionas tothecauseofdeathofMs.Militello. Dr.Singeropines
that Ms.Militellodiedas aresult ofa“sharpdropinhemoglobinwhichawomanthis agewith
multiplemedical problems couldnot tolerate.” (SeeDr.Singer’s report,April 14,2003,at 3;
attachedheretoas Ex.“B”)
34. Dr.Singer,inhis report,states that he“reviewedrecords”pertainingtoMs.
Militello’s admissiontoSt.Agnes Medical Center,betweenJune3,2001andJune13,2001.
(Ex.“B”,at 1) Dr.Singerprovides someoverviewofthecourseofMs.Militello’s
hospitalization(Ex.“B”,at 1-2),reviews brieflyherINR results andbrieflyherhemoglobin
levels, althoughfails toindicateacompletereviewofthoseresults. (Ex.“B”,at 2) Dr.Singer
states inhis report that Ms.Militellowas prescribedanexcessivedoseofCoumadinduringher
hospitalization,andthat this was dueto“erroneous INR’s.” (Ex.“B”,at 2)
35. Dr.Singerthenconcludes that Ms.MilitellodevelopedbleedingonJune13,
2001,afterseveral days of“overanticoagulation”withCoumadin,andthat shediedfrom
“cardiacarrest”becauseofthebleeding. (Ex.“B”,at 2-3) Dr.Singer’s solebasis forconcluding
that Ms.Militello“develop[ed]bleeding”is that onJune13,2001,herHemoglobinlevel
“droppedfrom 12.4to7.8,”thus indicatingalargeloss ofblood. (Ex.“B”,at 2-3)
36. Themedical records uponwhichDr.Singerrelies, however,donot reflect the
datauponwhichherelies. EvenPlaintiffs’ThirdAmendedComplaint fails toreflect this data.
ThePlaintiffs’allegethat onJune13,2001,Ms.Militello’s hemoglobinlevel was 7.8at 12:30
pm. (Ex.“A”,at¶47) ThePlaintiffs furtherallegethat herhemoglobinlevel was 12.4at 2:00
pm. (Ex.“A”,at ¶48) Preciselytheoppositeofthereadings uponwhichDr.Singerrelies
entirelyforhis opinion.
37. Ms.Militello’s DischargeSummary,likewisedemonstrates thefallacyoftheDr.
Singer’s opinionas tothecauseofMs.Militello’s death. (Seecopyofhemoglobin(“Hgb”)
results summaryfrom Ms.Militello’s DischargeSummary,attachedheretoas Ex.“G”) Rather
thandemonstratinga“falling”hemoglobinlevel duringheradmission,leadingtoherdeathon
June13,2001,nineout ofthetenresults duringtheJune2throughJune13,2001period